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When doctors order too many tests

Guests

H. Gilbert Welch:Professor of medicine at the Dartmouth Medical School

Steven Nissen:Chairman of the cardiovascular medicine department at the Cleveland Clinic Foundation

A visit to the doctor usually means some kind of testing or a prescription. But doctors are now advocating that sometimes no action during your visit is the best solution to your aches and pains.

A national campaign from the American Board of Internal Medicine Foundation debuted in April showcased 45 unnecessary and potentially dangerous tests that are performed too often in our health care system. And it's costing all of us: In 2009, the United States spent $210 billion on unnecessary medical procedures.

"Both patients and doctors have I think in the past viewed testing as something like, 'how can you go wrong? It never hurts to know,'" said H. Gilbert Welch, professor of medicine at the Dartmouth Medical School, on The Daily Circuit Thursday. "It's only been recently that we've sort of realized that in fact testing can unearth the start of a whole chain of events that aren't in the patient's interests."

The Board's list included procedures such as stress tests, CT scans and over-prescribing antibiotics.

Unneeded tests can lead to very serious complications, said Steven Nissen, chairman of the cardiovascular medicine department at the Cleveland Clinic Foundation, on The Daily Circuit.

In one instance Nissen cited, a patient underwent a CT scan of their coronaries for reasons that weren't strong enough to justify the test. The test result led to a heart catheterization, where a coronary was injured. The patient had a heart attack and eventually a heart transplant.

A lot of the over testing stems from a medical system that pays doctors based on the amount of work they do without checking to see if the work was actually needed, Nissen said.

"The problem is we've created what I like to call 'perverse incentives' where if you pay people to do things, even well-meaning people have a very strong incentive to do more," he said. "Unfortunately doing more testing doesn't necessarily make people healthier. "

Kristin in Wisconsin called into the program with an example. Several years ago, she mentioned a lump in her breast to her doctor during a clinic visit for a sinus infection. By the end of the day, she had seen five doctors and had a mammogram, MRI and an ultrasound. She was scheduled for a biopsy the next day. In total, it cost her $15,500.

That amount of testing can cause extreme stress for patients, which doctors should be wary of, Nissen said.

"When you tell a patient that they may have a serious disease based upon this kind of testing, it creates a whole cascade of anxieties that have real emotional consequences," he said.

It can also cause long-term physical damage to an otherwise healthy patient, Nissen said. If you do a CT scan of a woman's chest in her 30s or 40s, it could increase her lifetime risk of breast cancer by 1 in 200.

Patients can help protect themselves from over testing and over treating by being OK with a doctor's visit where they leave empty handed.

"We've begun to feel a clinic visit is not complete if it doesn't end with some action," Welch said. "That action is typically either a prescription for a medicine or an order for a test. Sometimes the best medicine is actually for no action to occur and I think we all need to begin to understand that."

On Facebook, Jennifer Miller said she thinks education is key.

"In [veterinary] medicine, no tests are allowed to be run until there is a full explanation to the owners of what the test is, why it's needed, the cost, and other options if they don't want to go that route," she wrote. "When you go to a human doctor, you are told what they are going to do without any discussion. This takes you out of the decision making process on your own health."